HomeMy WebLinkAboutX2021-2944 - Permit ApplicationPrint Form _ W heet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division
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NOTE:
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL "
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Project Address (Not mailing address) F Flood F_ Fire F_ Liq F_ Landslide FN/A Floor Suite No
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Description of Work
use Const Type
# Stories # Units (if R )
New/Add SF Remodel�SF� Valuation
Garage/ ew/Add �— Material/Labor /zsf jj C3-Q
OWNER'S NAME Last Fa First ` -0,�)
Owner's Address (� \
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Zip ZTelephone'/ 9 1 0
APPLICANT'S NAME Last
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Applicant's Address
Applicant's E-mail Ad ass
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City State �� ZiP q Telepho
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ARCHITECT/DESIGNER'S NAME Last First F — Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City State f ZiP F — Telephoner
ENGINEER'S NAME Last First�� _LI e U Lic. No.F—
Engineer's Address //��•�{
Engineer's E-mail Address
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State F— ZIP F— Telephone —
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CONTRACTOR'S NAME/COMPANY Lic. No. l(7 pg0 Class
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Contractor's Address Contractor's E-mail Address BT 7k369 Z-28-22
City State F �—
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
'ETBACKS LEFT SETBACKS RIGHT PLAN CHECK N ._91`
ZONE DEVELOPMENT NO PLAN CHECK FEES $